Provider Demographics
NPI:1407823610
Name:SCOTTSDALE MEDICAL IMAGING, LTD
Entity Type:Organization
Organization Name:SCOTTSDALE MEDICAL IMAGING, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:S
Authorized Official - Last Name:OWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-425-5000
Mailing Address - Street 1:9700 N 91ST ST STE C200
Mailing Address - Street 2:SCOTTSDALE MEDICAL IMAGING, LTD.
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5064
Mailing Address - Country:US
Mailing Address - Phone:480-425-5000
Mailing Address - Fax:480-425-5010
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:#130
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-425-5000
Practice Address - Fax:480-425-5010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ453621Medicaid
AZWCFKXMedicare PIN